Good AMH but poor response

[Hobbes39]

Hi, I was wondering if anyone experienced can help me get my head around this all as I'm really struggling. I am currently undergoing our first round of IVF due to unexplained secondary infertility.
while I know it's not over yet and only takes one, I'm feeling really down about where we are as I'm the day after Egg collection and we have only 2 eggs that fertilised properly, so things aren't looking great.
To explain, my AMH was 15.4, AFC 13-14, and my FSH and LH were 2.9 and 3.9, so all good. There appears to be nothing wrong with us, but I only managed to have 6 decent size follicles, 5 eggs retrieved and a fairly low 40% fertilisation rate. I'm devastated as with my numbers I had hoped for more to give us more chance that one will make it. Can anyone tell me if you have had good levels of everything but a poor response, and if so did you succeed? If not, did you do the whole thing again and do anything differently and get a better result? I'm not very good at accepting the 'unexplained' thing - there's clearly something wrong, I just wish I knew what...
thanks for reading x

Yes, I have an amh of 27 but on my first cycle I only had 1 measurable follicle and the cycle was cancelled before egg collection. I was on gonal-f and luveris on that cycle.

On my second cycle, I swapped the luveris for menopur and stayed on the gonal-f and got 16 eggs. 15 of them were mature but unfortunately only 1 fertilised (polyspermic fertilisation).
Amazingly though, that 1 embryo (3dt) was a good one and i'm 22 weeks pregnant.

Don't be disheartened. An increase/change in meds can make a huge difference.

Hi Hobbes, I know how you feel about the "unexplained" part - I don't buy it either! My AMH is same as yours and on first cycle only got two follicles and cycle was cancelled. The stim dose they guessed based on my AMH wasn't good enough for some unknown reason. This cycle they just upped my menopur, had 20 follicles at latest scan and today at EC got 12 eggs. So maybe you just need more stims? As for fertilisation, I'm waiting to find out tomorrow and I'm bricking it because I feel like maybe that's where the problem will lie. I said this to our consultant but he is continuing to claim that the most likely explanation is that there's nothing wrong and we've just been unlucky! For three years... So I can't offer you words of wisdom there yet other than to say I'm sorry you're disappointed and I can imagine how awful you feel. But Meredith is right, it does only take one so hold tight xx

Thanks Meredith and MrsC - I'm sorry you have both had cycles cancelled despite good AMH numbers - makes me realise how lucky I am to have got this far.
And, Thats lovely news Meredith, that it worked 2nd time around for you - you give me hope!
MrsC - good luck for tomorrow I hope you get good fertilisation rate xx
If you don't mind, can I ask how old you both are? I'm 39 and I feel a bit like the hospital didn't do more as they feel that at my age I shouldn't expect to get many, but then what's the point in doing AMH levels...
I was on the same 150 of Bemfola (gonal F) the whole time even after the first scan showed a low response, which confused me as I thought they'd up it, but my lining was doing well, so they didnt think they needed to... do you know what your lining looked like?
Thanks & good luck tomorrow MrsC and good luck for a happy health pregnancy Meredith! X

Thanks! I am 35.

My clinic was quite conservative with the meds on the first cycle too but I have polycystic ovaries so they wanted to go softly softly. They upped it for the second though when they saw the poor response I had first time round - some of my follicles shrunk during stimming!
My lining was good throughout (the only thing my reproductive system has going for it!).
Reading back on my last post, I'm sorry if I came across as all breezy and flippant -
it took us 6 years to get to this point and I know how lucky I am. The first ivf cycle seems to be a bit trial and error as the clinic are getting to know how you respond to the drugs.

I think the time after egg collection is a bit of an anti-climax. No matter how many eggs are collected or how many fertilise, you'll always wonder is it enough. But you are in a good position - you have 2 embryos and good lining which is exactly what you want at this stage. The very best of luck.

Mrscrabtree, all the best for tomorrow.

My one and only ivf cycle was nearly cancelled due to poor response. I was 33, amh was fine but I have polycystic ovaries and they were worried that I would get ohss if they gave me too high a dose of stims. They did keep upping it v gradually though and the final increase just before they pulled the cycle did the trick and I got loads of mature eggs in the end, 8 fertilised and 2 (one fresh, one frozen) successful transfers. From memory I'm pretty sure that the lining was growing fine, it was egg production that led them to up the dose. As others have said, if you need another cycle (fingers crossed you don't) you might get a better response from more/different stims.

Different angle here in that I have low amh so expected a poor response- which is what I got. I only had 2 eggs, 1 embryo. I was gutted and thought it was all over. However, that embryo is now almost 2 years old! Quality is far far more important than quantity.

Thanks for all your responses. Had a depressing call this morning - both my embryos have made it to day 2, and are 4 cell, but with quite high fragmentation so they are only grade 2 (4 being best, 1 worst). Having both put back in today. Chances aren't great, but still a chance. I'm not sure how to cope with the next 2 weeks.
This is such a shit process. I had no idea how lucky I was first time around - my DS took a while to conceive (about a year) and I thought at the time that was hard... wish I could go back to being hopelessly naive!

Good luck today Hobbes - thinking of you and those embryos sound good, you're definitely in with a chance. However yes it is a shit process! I may have used the phrase "f* this sh**" more than once yesterday.

In answer to your previous question I'm 36, and if you think your consultant isn't taking your good AMH seriously you should defo pull them up on it. Here's hoping you won't need to though! Lots of luck and good implantation vibes coming your way!

How are you getting on MrsC? Hope you have some good embryos for transfer? Thinking of you x

Hello Hobbes, thanks for thinking of me. We have 4 in the running and a planned 5day transfer on Monday, all being well, which is really good news so far.

How are you feeling? X

MrsC - wow, that's fantastic! 4 in the running for blasts is brilliant, good luck for Monday! If this doesn't work, and we if can afford another go I will be asking for upped stimms definitely
I'm ok, feeling oddly relaxed about it all at the moment - I imagine that will change next week.. feel really tired and physically a bit bruised and battered though :(

Hi - just to update - sadly this cycle has been unsuccessful. It's been a bit a headf*ck as I got my period on Sunday, 2 days before OTD - so went in with a heavy heart for my blood test on Tuesday saying I knew it would be negative as if had heavy bleeding with clots. Turns out it wasn't fully negative, I had an HCG level of just 7 - so while ridiculously low and therefore not viable, I was technically pregnant - so chemical pregnancy. Which seemed to me on Tuesday to be a bit of a kick in the teeth... but today I'm trying to think more positively about it, as at least it shows that my embryos tried and they nearly got there and hopefully the docs can learn something from all this...
What is depressing is waiting for it to go out my system and for me to NOT be pregnant anymore when all I really want is to be properly pregnant.

Anyway, how are you getting on Mrs C? You must be close to test date? Hope your news is better than mine!

Hi Hobbes, so sorry to hear that news and what a total headf* to find out about the chemical. But as you say, it does at least show your embies were fighters - if you decide to have another go fingers crossed a few tweaks will get you a better result. Still crap though, I feel for you.

Thanks for thinking of me. OTD is Sunday 18th. But I might test tomorrow as that will be equivalent of 16dpo. Only symptoms atm are cramps every night at about 1am! Im sure it's just the progesterone. Very nervous about testing but consoling myself with thoughts of excess champagne over Christmas if negative xxx

Sorry to hear period came hobbles in cycle 1&2 I came on day 11 and heartbreaking

I would advise talking to clinic and upping drugs to get more follicles and eggs

It's a fine line as too much and ohss cane Happen so think clinics take it lower first cycle while they learn about your reactions rather then find blazing and over drug you

Hello Hobbes, a quick update for you - cautious BFP for me this morning xxx

Aww, mrs C - that's fantastic! Will keep everything crossed for you that all progresses well xx

Thank you I hope you're ok too xx